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Aberrant Vascular Anatomy to the Small Finger
CLINICAL CORNER Aberrant Vascular Anatomy to the Small Finger Ryan T. Rubright, Caitlin Gannon, BS, Mark E. Baratz, MD From the Division of Upper Extremity Surgery, Department of Orthopaedics, Allegheny General Hospital, Pittsburgh, PA.
uring a palmer approach to the small finger to repair the flexor digitorum profundus tendon a vessel was encountered crossing the flexor sheath. The vessel originated from the radial digital artery and crossed the flexor sheath at the distal margin of the A2 pulley. The vessel caliber was equivalent to the proper radial digital artery. The vessel was joined by a small-caliber ulnar digital artery and then terminated into small subcutaneous vessels at the level of the proximal interphalangeal joint (Fig. 1). Variations of the palmer arch were documented as early as 1961. Coleman and Anson1 described the vascular anatomy of the hand after dissecting 650 cadaver specimens. They found a complete arch in 510 (78.4%) hands. In a subset of 265 hands, 5 (1.9%) had no common digital vessel to the middle and ring fingers. As a result, the middle finger had a single radial digital vessel from the common digital
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artery to the index and middle fingers. The ring finger had a single ulnar digital vessel from the common digital artery to the ring and small fingers. In that same subset of 265 hands, 4 (1.5%) had no common digital artery to the ring and small fingers. This left a single ulnar digital artery from the superficial arch to provide the blood supply via the ulnar half of the small finger. In most hands the ulnar digital artery emanates from the superficial arch at the distal margin of the transverse carpal ligament. Windisch2 described an aberrant, proximal take-off of the ulnar digital artery to the small finger in a cadaver specimen. The ulnar digital artery arose from the main trunk of the ulnar artery just distal to the pisiform. The vessel gave off several branches to the hypothenar muscles, crossed the superficial branch of the ulnar nerve, and coursed to the ulnar aspect of the small finger. In our patient,
Figure 1. Vessel originating from the radial digital artery, crossing the flexor sheath at the distal margin of the A2 pulley, and then terminating into small subcutaneous vessels at the level of the proximal interphalangeal joint.
1514
The Journal of Hand Surgery
Rubright, Gannon, and Baratz / Small Finger Aberrant Vascular Anatomy
the usually dominant ulnar digital artery to the small finger was hypoplastic. The radial digital artery was the dominant vessel, supplying the radial half of the finger along with a larger caliber branch to the ulnar half of the finger. Although these aberrant branches are infrequently described, based on the work of Coleman and Anson,1 the average hand surgeon should expect these anomalous vessels in 1% to 2% of patients. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
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Corresponding author: Mark E. Baratz, MD, Division of Upper Extremity Surgery, Department of Orthopaedics, Allegheny General Hospital, Pittsburgh, PA 15212; e-mail: [email protected]. Copyright © 2006 by the American Society for Surgery of the Hand 0363-5023/06/31A09-0016$32.00/0 doi:10.1016/j.jhsa.2006.08.021
References 1. Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstetr 1961; 113:409 – 424. 2. Windisch G. Unusual vascularization and nerve supply of the fifth finger. Ann Anat 2006;18:171–175.
uring a palmer approach to the small finger to repair the flexor digitorum profundus tendon a vessel was encountered crossing the flexor sheath. The vessel originated from the radial digital artery and crossed the flexor sheath at the distal margin of the A2 pulley. The vessel caliber was equivalent to the proper radial digital artery. The vessel was joined by a small-caliber ulnar digital artery and then terminated into small subcutaneous vessels at the level of the proximal interphalangeal joint (Fig. 1). Variations of the palmer arch were documented as early as 1961. Coleman and Anson1 described the vascular anatomy of the hand after dissecting 650 cadaver specimens. They found a complete arch in 510 (78.4%) hands. In a subset of 265 hands, 5 (1.9%) had no common digital vessel to the middle and ring fingers. As a result, the middle finger had a single radial digital vessel from the common digital
D
artery to the index and middle fingers. The ring finger had a single ulnar digital vessel from the common digital artery to the ring and small fingers. In that same subset of 265 hands, 4 (1.5%) had no common digital artery to the ring and small fingers. This left a single ulnar digital artery from the superficial arch to provide the blood supply via the ulnar half of the small finger. In most hands the ulnar digital artery emanates from the superficial arch at the distal margin of the transverse carpal ligament. Windisch2 described an aberrant, proximal take-off of the ulnar digital artery to the small finger in a cadaver specimen. The ulnar digital artery arose from the main trunk of the ulnar artery just distal to the pisiform. The vessel gave off several branches to the hypothenar muscles, crossed the superficial branch of the ulnar nerve, and coursed to the ulnar aspect of the small finger. In our patient,
Figure 1. Vessel originating from the radial digital artery, crossing the flexor sheath at the distal margin of the A2 pulley, and then terminating into small subcutaneous vessels at the level of the proximal interphalangeal joint.
1514
The Journal of Hand Surgery
Rubright, Gannon, and Baratz / Small Finger Aberrant Vascular Anatomy
the usually dominant ulnar digital artery to the small finger was hypoplastic. The radial digital artery was the dominant vessel, supplying the radial half of the finger along with a larger caliber branch to the ulnar half of the finger. Although these aberrant branches are infrequently described, based on the work of Coleman and Anson,1 the average hand surgeon should expect these anomalous vessels in 1% to 2% of patients. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
1515
Corresponding author: Mark E. Baratz, MD, Division of Upper Extremity Surgery, Department of Orthopaedics, Allegheny General Hospital, Pittsburgh, PA 15212; e-mail: [email protected]. Copyright © 2006 by the American Society for Surgery of the Hand 0363-5023/06/31A09-0016$32.00/0 doi:10.1016/j.jhsa.2006.08.021
References 1. Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstetr 1961; 113:409 – 424. 2. Windisch G. Unusual vascularization and nerve supply of the fifth finger. Ann Anat 2006;18:171–175.